Capitalist society faces one of its greatest challenges in the beginning of the millennium: How can sustainable social, economic and environmental development be reconciled with capitalist drivers of efficiency and generation of profits? With increasing international integration and pressure from financial markets, typical of the current neoliberal power model, it calls into question the extent to which corporations can make elections truly free in order to build a more responsible world. Furthermore, it is worth questioning whether it is possible to demand or even expect that states and governmental institutions participate and intervene more in society with increasing budgetary constraints and loss of autonomy. Based on these concerns about the role of corporations and about the validity of the concepts of corporate social responsibility and sustainability, this research aimed to evaluate CSR practices by using the pharmaceutical sector as an empirical reference and analyzing social and environmental performance indicators, the influence of the institutional framework of national systems and strategic execution case studies of two pharmaceutical corporations within the institutional frameworks of Brazil and Spain. The study demonstrated the importance of legal and regulatory frameworks by conditioning and limiting decision-making about access to medicine, which foster or undermine responsible behavior by organizations. The research concludes that the institutional framework has a paramount effect on the result of the interaction between corporations and society, through public policies intelligently conceived to promote the highest possible level of general welfare. In the case of the pharmaceutical sector, policies to adequately remunerate capital to offset the business risk of investing in research and development and, at the same time, promote the general public’s highest possible level of access to advances in biotechnology and biomedical research.